Més obesitat desemboca en més artrosi : resultats d'un estudi a Catalunya

Es calcula que l'any 2030 hi haurà uns 573 milions de persones obeses al món. A banda del gran nombre de dolències que s'hi relacionen, ara els experts han descobert que contra més alt és el pes de les persones, més risc tenen de patir artrosi. Es tracta d'un deteriorament del cartílag de les articulacions que provoca dolor i dificultat de moviment, que pot arribar a afectar l'autonomia dels afectats.Se calcula que el año 2030 habrá unas 573 personas obesas. Aparte del cúmulo de dolencias que conlleva, los expertos han descubierto que cuanto más alto es el peso de las personas, más riesgo tienen de sufrir artrosis. Se trata de un deterioro del cartílago de las articulaciones que provoca dolor y dificultad en el movimiento, hasta llegar a afectar la autonomía de los afectados.It is estimated that, by 2030, obese population will increase to 573 million. Apart from other diseases related to obesity, experts have discovered that the higher the weight of people, the more likely they are to have osteoarthritis. Osteoarthritis is a deterioration of the cartilage of the joints that causes pain and difficulty in movement, and even can affect one's autonomy

Las comorbilidades y el consumo de inhibidores de la bomba de protones como factores de riesgo secundarios en la fractura de cadera en una población española.

Objectiu: Determinar l' associació entre els inhibidors de la bomba de protons (IBP) i les comorbiditats incloses en l' índex de Charlson amb la fractura de maluc. Metodologia: Estudi 1- Estudi de cassos i controls retrospectiu. Criteris d' inclusió: >50 anys i haver patit fractura de maluc (2007 - 2010). Aparellament de 2 controls per cada cas. Es va analitzar el consum d' IBP durant els 5 anys previs a la fractura de maluc. Estudi 2- Estudi de cohorts retrospectiu (base de dades SIDIAP). Criteris d' inclusió: Tots els homes registrats (2007). Seguiment : 3 anys. Es van enregistrar les comorbiditats incloses en l' índex de Charlson i les fractures de maluc (2007-2009). Resultats: Estudi 1- Es van analitzar 358 cassos i 698 controls. No es va detectar una associació entre el consum d'IBP i la fractura de maluc (OR ajustada 1,24 (95% IC: 0,93-1,65; p=0,14). Estudi 2- Es va estudiar 186.171 homes (1718 fractures). La diabetis (RR ajustat de 1,89 (95% IC: 1,15-3,12), la MPOC (RR ajustat de 1,20 (95% IC: 1,03-1,40), la malaltia renal crònica (RR ajustat de 1,32 (95% IC: 1,07-1,65), el VIH (RR ajustat de 5,03 (95% IC: 1,25-20,21), la demència (RR ajustat de 1,65 (95% IC: 1,30-2,09), la malaltia vascular cerebral (RR ajustat de 1,51 (95% IC: 1,27-1,80), l'hepatopatia lleu (RR ajustat de 1,53 (95% IC: 1,10-2,13) i una puntuació superior a 3 a l' índex de Charlson es van associar amb un increment del 50% de risc de fractura de maluc. Conclusió: Els IBP no es van associar amb un increment de risc a la nostra regió, però vàries comorbiditats incloses a l’índex de Charlson o una puntuació superior a 3 si que es van associar amb un increment del risc de fractura de maluc en homesObjetivo: Determinar la asociación entre los inhibidores de la bomba de protones (IBP) y las comorbildades incluidas en el índice de Charlson con la fractura de cadera (FC). Metodología: Estudio 1- Estudio de casos y controles retrospectivo. Criterios inclusión: > 50 años y tener fractura de cadera (2007 – 2010). Emparejamiento de 2 controles por cada caso. Se analizó el consumo de IBP en los 5 años previos a la fractura de cadera. Estudio 2- Estudio de cohortes retrospectivo (base de datos SIDIAP). Criterios inclusión: Todos los hombres registrados (2007) . Seguimiento: 3 años. Se registraron las comorbilidades incluidas en el índice de charlson y las fracturas de cadera (2007- 2009). Resultados: Estudio 1- Se analizaron 358 casos y 698 controles. No se detectó una asociación entre el consumo de IBP y la FC (OR ajustada 1,24 (95% IC: 0,93-1,65; p=0,14). Estudio 2- Se estudiaron 186171 hombres (1718 fracturas de cadera). La diabetes (RR ajustado de 1,89 (95% IC: 1,15-3,12), la EPOC (RR ajustado de 1,20 (95% IC: 1,03-1,40), la enfermedad renal crónica (RR ajustado de 1,32 (95% IC: 1,07-1,65)), el VIH (RR ajustado de 5,03 (95% IC: 1,25-20,21), la demencia (RR ajustado de 1,65 (95% IC: 1,30-2,09), la enfermedad cerebral vascular (RR ajustado de 1,51 (95% IC: 1,27-1,80), la hepatopatía leve (RR ajustado de 1,53 (95% IC: 1,10-2,13)) y una puntuación >3 en el índice de Charlson fueron asociada con un incremento del 50% de riesgo de FC. Conclusión: Los IBP no se asociaron con un incremento de riesgo en nuestra región, sin embargo varias comorbilidades incluidas en el índice de charlson al igual que un puntuación de >3 si que se asociaron con un incremento de riesgo de fractura de cadera en hombres.Aim: To determine the association between the proton pump inhibitors (PPI) and the comorbidities included in the Comorbidity Charlson Index with the hip fracture (HF). Methods: Study 1- Retrospective case-control study. Inclusion criteria: >50 years old with a hip fracture (2007-2010). Matching: 2 controls per case. We analyzed the consumption of PPI in the 5 years previous to the hip fracture. Study 2- Retrospective cohort study using the SIDIAP dababase. Inclusion criteria: All the men registered in the database by 2007. Follow-up: 3 years. We registered all the comorbidities included in the Charlson Index and all the hip fracture (2007-2009). Results: Study 1- A total of 358 cases and 698 controls were analyzed. No association was detected between the consumption of PPI and the HF (Adjusted OR 1.24 (95% CI: 0.93-1.65; p=0.14). Study 2- A total of 186,171 men were analyzed (1718 hip fractures). The diagnosis of diabetes (adjusted RR of 1.89 (95% CI: 1.15-3.12), COPD (adjusted RR of 1.20 (95% CI: 1.03-1.40), chronic kidney disease (adjusted RR of 1.32 (95% CI: 1.07-1.65), HIV (adjusted RR of 5.03 (95% CI: 1.25-20.21), dementia (adjusted RR of 1.65 (95% CI: 1.30-2.09), cerebrovascular disease (adjusted RR of 1.51 (95% CI: 1.27-1.80), mild liver disease (adjusted RR of 1.53 (95% CI: 1.10-2.13) and a puntuation >3 in the Chalson index was associated with a 50% increased risk of HF. Conclusion: The PPI was not associated with an increased risk of hip fracture in our region, never the less several comorbidities included in the Chalson index as well as a punctuation of at least 3 was asosciated with the hip fracture in men

An exact solution of the inelastic Boltzmann equation for the Couette flow with uniform heat flux

In the steady Couette flow of a granular gas the sign of the heat flux gradient is governed by the competition between viscous heating and inelastic cooling. We show from the Boltzmann equation for inelastic Maxwell particles that a special class of states exists where the viscous heating and the inelastic cooling exactly compensate each other at every point, resulting in a uniform heat flux. In this state the (reduced) shear rate is enslaved to the coefficient of restitution $\alpha$, so that the only free parameter is the (reduced) thermal gradient $\epsilon$. It turns out that the reduced moments of order $k$ are polynomials of degree $k-2$ in $\epsilon$, with coefficients that are nonlinear functions of $\alpha$. In particular, the rheological properties ($k=2$) are independent of $\epsilon$ and coincide exactly with those of the simple shear flow. The heat flux ($k=3$) is linear in the thermal gradient (generalized Fourier's law), but with an effective thermal conductivity differing from the Navier--Stokes one. In addition, a heat flux component parallel to the flow velocity and normal to the thermal gradient exists. The theoretical predictions are validated by comparison with direct Monte Carlo simulations for the same model.Comment: 16 pages, 4 figures,1 table; v2: minor change

Trends of use and characterisation of anti-dementia drugs users:a large multinational-network population-based study

Background: An updated time-trend analysis of anti-dementia drugs (ADDs) is lacking. The aim of this study is to assess the incident rate (IR) of ADD in individuals with dementia using real-world data. Setting: Primary care data (country/database) from the UK/CPRD-GOLD (2007–20), Spain/SIDIAP (2010–20) and the Netherlands/IPCI (2008–20), standardised to a common data model. Methods: Cohort study. Participants: dementia patients ≥40 years old with ≥1 year of previous data. Follow-up: until the end of the study period, transfer out of the catchment area, death or incident prescription of rivastigmine, galantamine, donepezil or memantine. Other variables: age/sex, type of dementia, comorbidities. Statistics: overall and yearly age/sex IR, with 95% confidence interval, per 100,000 person-years (IR per 105 PY (95%CI)). Results: We identified a total of (incident anti-dementia users/dementia patients) 41,024/110,642 in UK/CPRD-GOLD, 51,667/134,927 in Spain/SIDIAP and 2,088/17,559 in the Netherlands/IPCI. In the UK, IR (per 105 PY (95%CI)) of ADD decreased from 2007 (30,829 (28,891–32,862)) to 2010 (17,793 (17,083–18,524)), then increased up to 2019 (31,601 (30,483 to 32,749)) and decrease in 2020 (24,067 (23,021–25,148)). In Spain, IR (per 105 PY (95%CI)) of ADD decreased by 72% from 2010 (51,003 (49,199–52,855)) to 2020 (14,571 (14,109–15,043)). In the Netherlands, IR (per 105 PY (95%CI)) of ADD decreased by 77% from 2009 (21,151 (14,967–29,031)) to 2020 (4763 (4176–5409)). Subjects aged ≥65–79 years and men (in the UK and the Netherlands) initiated more frequently an ADD. Conclusions: Treatment of dementia remains highly heterogeneous. Further consensus in the pharmacological management of patients living with dementia is urgently needed.</p

Trends of use and characterisation of anti-dementia drugs users:a large multinational-network population-based study

Background: An updated time-trend analysis of anti-dementia drugs (ADDs) is lacking. The aim of this study is to assess the incident rate (IR) of ADD in individuals with dementia using real-world data. Setting: Primary care data (country/database) from the UK/CPRD-GOLD (2007–20), Spain/SIDIAP (2010–20) and the Netherlands/IPCI (2008–20), standardised to a common data model. Methods: Cohort study. Participants: dementia patients ≥40 years old with ≥1 year of previous data. Follow-up: until the end of the study period, transfer out of the catchment area, death or incident prescription of rivastigmine, galantamine, donepezil or memantine. Other variables: age/sex, type of dementia, comorbidities. Statistics: overall and yearly age/sex IR, with 95% confidence interval, per 100,000 person-years (IR per 105 PY (95%CI)). Results: We identified a total of (incident anti-dementia users/dementia patients) 41,024/110,642 in UK/CPRD-GOLD, 51,667/134,927 in Spain/SIDIAP and 2,088/17,559 in the Netherlands/IPCI. In the UK, IR (per 105 PY (95%CI)) of ADD decreased from 2007 (30,829 (28,891–32,862)) to 2010 (17,793 (17,083–18,524)), then increased up to 2019 (31,601 (30,483 to 32,749)) and decrease in 2020 (24,067 (23,021–25,148)). In Spain, IR (per 105 PY (95%CI)) of ADD decreased by 72% from 2010 (51,003 (49,199–52,855)) to 2020 (14,571 (14,109–15,043)). In the Netherlands, IR (per 105 PY (95%CI)) of ADD decreased by 77% from 2009 (21,151 (14,967–29,031)) to 2020 (4763 (4176–5409)). Subjects aged ≥65–79 years and men (in the UK and the Netherlands) initiated more frequently an ADD. Conclusions: Treatment of dementia remains highly heterogeneous. Further consensus in the pharmacological management of patients living with dementia is urgently needed.</p

Validation of an electronic frailty index with electronic health records: eFRAGICAP index

Objective: To create an electronic frailty index (eFRAGICAP) using electronic health records (EHR) in Catalunya (Spain) and assess its predictive validity with a two-year follow-up of the outcomes: homecare need, institutionalization and mortality in the elderly. Additionally, to assess its concurrent validity compared to other standardized measures: the Clinical Frailty Scale (CFS) and the Risk Instrument for Screening in the Community (RISC). Methods: The eFRAGICAP was based on the electronic frailty index (eFI) developed in United Kingdom, and includes 36 deficits identified through clinical diagnoses, prescriptions, physical examinations, and questionnaires registered in the EHR of primary health care centres (PHC). All subjects > 65 assigned to a PHC in Barcelona on 1st January, 2016 were included. Subjects were classified according to their eFRAGICAP index as: fit, mild, moderate or severe frailty. Predictive validity was assessed comparing results with the following outcomes: institutionalization, homecare need, and mortality at 24 months. Concurrent validation of the eFRAGICAP was performed with a sample of subjects (n = 333) drawn from the global cohort and the CFS and RISC. Discrimination and calibration measures for the outcomes of institutionalization, homecare need, and mortality and frailty scales were calculated. Results: 253,684 subjects had their eFRAGICAP index calculated. Mean age was 76.3 years (59.5% women). Of these, 41.1% were classified as fit, and 32.2% as presenting mild, 18.7% moderate, and 7.9% severe frailty. The mean age of the subjects included in the validation subsample (n = 333) was 79.9 years (57.7% women). Of these, 12.6% were classified as fit, and 31.5% presented mild, 39.6% moderate, and 16.2% severe frailty. Regarding the outcome analyses, the eFRAGICAP was good in the detection of subjects who were institutionalized, required homecare assistance, or died at 24 months (c-statistic of 0.841, 0.853, and 0.803, respectively). eFRAGICAP was also good in the detection of frail subjects compared to the CFS (AUC 0.821) and the RISC (AUC 0.848). Conclusion: The eFRAGICAP has a good discriminative capacity to identify frail subjects compared to other frailty scales and predictive outcomes

Impact of the COVID-19 pandemic on diagnoses of common mental health disorders in adults in Catalonia, Spain : a population-based cohort study

To investigate how trends in incidence of anxiety and depressive disorders have been affected by the COVID-19 pandemic. Population-based cohort study. Retrospective cohort study from 2018 to 2021 using the Information System for Research in Primary Care (SIDIAP) database in Catalonia, Spain. 3 640 204 individuals aged 18 or older in SIDIAP on 1 March 2018 with no history of anxiety and depressive disorders. The incidence of anxiety and depressive disorders during the prelockdown period (March 2018-February 2020), lockdown period (March-June 2020) and postlockdown period (July 2020-March 2021) was calculated. Forecasted rates over the COVID-19 periods were estimated using negative binomial regression models based on prelockdown data. The percentage of reduction was estimated by comparing forecasted versus observed events, overall and by sex, age and socioeconomic status. The incidence rates per 100 000 person-months of anxiety and depressive disorders were 151.1 (95% CI 150.3 to 152.0) and 32.3 (31.9 to 32.6), respectively, during the prelockdown period. We observed an increase of 37.1% (95% prediction interval 25.5 to 50.2) in incident anxiety diagnoses compared with the expected in March 2020, followed by a reduction of 15.8% (7.3 to 23.5) during the postlockdown period. A reduction in incident depressive disorders occurred during the lockdown and postlockdown periods (45.6% (39.2 to 51.0) and 22.0% (12.6 to 30.1), respectively). Reductions were higher among women during the lockdown period, adults aged 18-34 years and individuals living in the most deprived areas. The COVID-19 pandemic in Catalonia was associated with an initial increase in anxiety disorders diagnosed in primary care but a reduction in cases as the pandemic continued. Diagnoses of depressive disorders were lower than expected throughout the pandemic

Childhood overweight and obesity and back pain risk : a cohort study of 466 997 children

To assess the association between age, sex, socioeconomic group, weight status and back pain risk in a large general population cohort of children. A dynamic cohort of children aged 4 years in the Information System for Research in Primary Care (SIDIAP) electronic primary care records data in Catalonia. Multivariable Cox models were fitted to explore the association between back pain and weight status categories according to the WHO 2007 growth reference groups (body mass index for age z-score). Models were adjusted for age, sex, socioeconomic status and nationality. Children seen at age 4 years at paediatric primary care clinics between 1 January 2006 and 31 December 2013 and followed up until 31 December 2016 or age 15 years. Incident back pain registered by paediatricians at primary care using the International Statistical Classification of Diseases and Health Related Problems, 10th Edition code M54. 466 997 children were followed for a median 5.0 years (IQR 5.1). In multivariable models, overweight and obesity increased back pain risk, with adjusted HRs of 1.18 (95% CI 1.09 to 1.27) and 1.34 (95%CI 1.19 to 1.51) for overweight and obesity, respectively. Females were at greater risk of back pain than males with adjusted HR 1.40 (95%CI 1.35 to 1.46). Adjusted HR was 1.43 (95%CI 1.33 to 1.55) for back pain in children from the most deprived socioeconomic groups compared with the least deprived socioeconomic groups. Maintaining a healthy weight from an early age may reduce the prevalence of back pain in both children and adults. Overweight female children from deprived socioeconomic groups are at greatest risk of back pain and represent a target population for intervention

Real-world treatment trajectories of adults with newly diagnosed asthma or COPD

Background There is a lack of knowledge on how patients with asthma or chronic obstructive pulmonary disease (COPD) are globally treated in the real world, especially with regard to the initial pharmacological treatment of newly diagnosed patients and the different treatment trajectories. This knowledge is important to monitor and improve clinical practice. Methods This retrospective cohort study aims to characterise treatments using data from four claims (drug dispensing) and four electronic health record (EHR; drug prescriptions) databases across six countries and three continents, encompassing 1.3 million patients with asthma or COPD. We analysed treatment trajectories at drug class level from first diagnosis and visualised these in sunburst plots. Results In four countries (USA, UK, Spain and the Netherlands), most adults with asthma initiate treatment with short-acting ß2 agonists monotherapy (20.8%-47.4% of first-line treatments). For COPD, the most frequent first-line treatment varies by country. The largest percentages of untreated patients (for asthma and COPD) were found in claims databases (14.5%-33.2% for asthma and 27.0%-52.2% for COPD) from the USA as compared with EHR databases (6.9%-15.2% for asthma and 4.4%-17.5% for COPD) from European countries. The treatment trajectories showed step-up as well as step-down in treatments. Conclusion Real-world data from claims and EHRs indicate that first-line treatments of asthma and COPD vary widely across countries. We found evidence of a stepwise approach in the pharmacological treatment of asthma and COPD, suggesting that treatments may be tailored to patients' needs.</p

Real-world treatment trajectories of adults with newly diagnosed asthma or COPD

Background There is a lack of knowledge on how patients with asthma or chronic obstructive pulmonary disease (COPD) are globally treated in the real world, especially with regard to the initial pharmacological treatment of newly diagnosed patients and the different treatment trajectories. This knowledge is important to monitor and improve clinical practice. Methods This retrospective cohort study aims to characterise treatments using data from four claims (drug dispensing) and four electronic health record (EHR; drug prescriptions) databases across six countries and three continents, encompassing 1.3 million patients with asthma or COPD. We analysed treatment trajectories at drug class level from first diagnosis and visualised these in sunburst plots. Results In four countries (USA, UK, Spain and the Netherlands), most adults with asthma initiate treatment with short-acting ß2 agonists monotherapy (20.8%-47.4% of first-line treatments). For COPD, the most frequent first-line treatment varies by country. The largest percentages of untreated patients (for asthma and COPD) were found in claims databases (14.5%-33.2% for asthma and 27.0%-52.2% for COPD) from the USA as compared with EHR databases (6.9%-15.2% for asthma and 4.4%-17.5% for COPD) from European countries. The treatment trajectories showed step-up as well as step-down in treatments. Conclusion Real-world data from claims and EHRs indicate that first-line treatments of asthma and COPD vary widely across countries. We found evidence of a stepwise approach in the pharmacological treatment of asthma and COPD, suggesting that treatments may be tailored to patients' needs.</p